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Click here for more sample CPC practice exam questions and answers with full rationale

36902 & 36558 denying

We have recently received a denial from Medicare for 36902 being billed with 36558 & 76937 all done on the same day. 36558 & 76937 paid however 36902 kicked for pre/post-operative care payment is included in the allowance for the surgery/procedure. The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.
I am confused as I am not seeing any bundling issues. Is anyone else having this same denial?

Thank you!

Medical Billing and Coding Forum

CPT 11102 & 11103 denying as in global/apart of another procedure

Hello,

I have a few claims from particularly Premera and Amerigroup – but they are denying CPT codes 11102 & 11103 when billed together, even with no office visit or other procedure. I called in to ask and I am told there is a CCI edit but I find no edits between these two codes. Is anyone else having this issue?

Medical Billing and Coding Forum

11042 denying

Medicare Indiana constantly denies 11042 for patient who are seen weekly or after. Can someone help me code it properly with modifier to get the code paid. These are patients that comes to have ulcer debrided by the doctors.

Am I missing something?? i have used mod 59,79 even 58 to get the code paid but denies for "not deemed medical necessity". Please Help!!

Medical Billing and Coding Forum

Wiki Need help why Medicaid-AL been denying CPT 36902

Hello, we billed 36902 by itself and MCD-Alabama has been denying it for " M49: Missing/incomplete/invalid value code(s) or amount(s).
N59: Please refer to your provider manual for additional program and provider information." ANyone help me please…Thank you.

Medical Billing and Coding Forum

Anthem BCBS Denying 2nd Eye Cataract Surgery

Is anyone having issues with Anthem denying/rejecting the second eye cataract surgery within global of the first eye as "modifier used is inconsistent with procedure?"

66984 – RT w/ ICD-10: H25.811
66984 – 79, LT w/ ICD-10: H25.812

We have never had issues before and cannot get through to a live provider or customer service rep. Thank you for any suggestions.

Medical Billing and Coding Forum

BCBS denying mod 59 on vaccine administration code 90471

Recently, we have gotten several denials from various BCBS plans for modifier 59 on vaccine administration code 90471. The remark code says "procedure modifier was invalid on date of service". One patient called BCBS and was told modifier 59 is invalid on this service. Is this a glitch within BCBs or has something changed with modifier 59 guidelines? I’ve searched online and can’t find any changes where I should not be allowed to use modifier 59 on the administration codes. Example of charges:

99215 mod 25
90670-for pneumonia vaccine medicine
90471 mod 59 for vaccine admin code

Medical Billing and Coding Forum

Claims Denying from BCBS for LDL Cholesterol

We have began getting denials from BCBS regarding the LDL Cholesterol test (CPT 83721) stating that due to NCCI, it is not billable seperate if Triglyceride is >= 400mg/dl. We have never been denied before. Is anyone else having this issue recently? In reading the NCCI edits, this is correct but confused b/c we have never been denied before.

Medical Billing and Coding Forum

BCBS Denying WWE exam code??

Hey there! Looking for suggestions… BCBS is denying a wwe visit with the code 99395. I have never billed a wwe any other way (except for a new pt).
They have said that it is a medical code not a wellness visit?? The only other codes I see for wellness type exams are the G codes for medicare which doesn’t apply.
Any suggestions?? I am at loss! 14yrs OB coding…never ran into this!

Medical Billing and Coding Forum

77080-26 Bone Density Interp. Denying Palmetto GBA

77080 with modifier 26 for interp. is denying through Palmetto GBA with denial code- N130-Consult plan benefit documents/guidelines for information about restrictions for this service. I can’t find anything on CMS on why this is denying. Our physician’s file the interp. only and hospital files the TC portion. Does anyone know of any reason these would be denying? Has the benefit changed on these??/ Any help will be appreciated.

Medical Billing and Coding Forum